This provides a summary of Mitral Stenosis as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
MITRAL STENOSIS
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Presentation
§ Exertional dyspnoea
o Due to raised atrial pressures and pulmonary venous HTN
§ Haemoptysis
o Vascular congestion
§ Chest pain
§ Breathlessness
§ AF
§ Mitral facies (malar flush)
§ Pulmonary hypertension ® right ventricular heave, prominent a wave
§ Right HF ® raised JVP, peripheral oedema, hepatomegaly
Murmur ® mid-diastolic (bell), patient lying on left side whilst breath held in expiration.
Ortner syndrome ® horse voice occurring 2nd to LA enlargement, causing left recurrent laryngeal nerve palsy.
Patients with MS are at increased risk of thromboembolic events.
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Pathophysiology
Valvular obstruction to flow from the LA to LV.
§ Mitral valve ® bicuspid valve sitting between LA and LV
§ Most commonly results from rheumatic heart disease
o Complication of infection from Group A Streptococcus pharyngitis
o Results from molecular mimicry ® cross reactivity of antibodies produced to combat GAS with normal tissues
o Atrial and mitral valves most commonly affected
o Most recover from acute episode, but some go on to develop progressive valvular disease
o Chronic phase may not present for many years
o Stenosis, regurgitation or a mixed picture can be seen
§ Other causes include:
o Congenital MS
o Mitral annular calcification
o Radiation-associated
o Carcinoid associated valve disease
o Fabry’s disease
§ Lutembacher syndrome ® combination of ASD and MS (typically related to rheumatic heart disease)
§ MS results in ® raised LA pressures and atrial remodelling
§ Resistance to blood flow between the LA and LV ® increase in transmitral gradient
o As MS progresses ® raised pressures in LA
§ May only occur during exercise, but in more severe disease at rest
o As the valve area decreases, progressive symptoms develop
§ LA enlargement occurs in the presence of chronically elevated pressures
o Predisposed to AF and thrombosis
o Raised atrial pressures ® raised pulmonary venous pressures ® pulmonary hypertension ® right sided HF.
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